A 54-year-old man with schizophrenia presented with a 4-month history of an enlarged left hemiscrotum. He complained of intermittent, painless scrotal bleeding and denied abdominal or back pain. No history of recent weight loss, scrotal trauma, prior urinary tract infections, or genitourinary surgery was elicited. The physical examination showed a large, left hemiscrotal mass with anterior wall ulceration, a normal right testis, no inguinal adenopathy, and a normal abdomen without masses or tenderness (Fig. 1). The laboratory evaluation revealed a leukocytosis of 16.5 10 white blood cells/ L, with a hematocrit of 35%, creatinine 1.0 mg/dL, and normal liver function tests. Alpha-fetoprotein and human chorionic gonadotropin were normal. Scrotal ultrasonography revealed poor visualization of the right testis with a left hemiscrotal mass consistent with a hematoma. Computed tomography of the chest, abdomen, and pelvis showed a large mass in the left hemiscrotum with an associated left inguinal hernia (Fig. 2). The chest and abdominal computed tomography scans were normal with no retroperitoneal or inguinal adenopathy. He underwent inguinal orchiectomy with scrotoplasty and resection of a 21 29 15-cm tumor. The right testis was normal on exploration. The pathologic evaluation showed high-grade, poorly differentiated, liposarcoma with rhabdomyosarcomatous elements and involvement of the associated hernia sack (Fig. 3). He underwent adjuvant chemotherapy consisting of adriamycin and ifosfamide and was without evidence of metastatic disease or local recurrence at the termination of the chemotherapy.